Healthcare Provider Details

I. General information

NPI: 1265131676
Provider Name (Legal Business Name): PSYCHGENESIS MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5695 OAK ST
LAS VEGAS NV
89120-1936
US

IV. Provider business mailing address

5695 OAK ST
LAS VEGAS NV
89120-1936
US

V. Phone/Fax

Practice location:
  • Phone: 702-849-3767
  • Fax: 702-441-1652
Mailing address:
  • Phone: 702-849-3767
  • Fax: 702-441-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EVA MARIA RIVERA
Title or Position: OWNER
Credential: NP-C
Phone: 702-849-3767